Surgical approaches to low anovaginal fistula in Crohn's disease.

ABSTRACT

BACKGROUND: Anovaginal fistula due to Crohn's disease can be surgically repaired in some women. The purpose of this study was to analyze the types of fistula along with the features that point to success or failure in treating these patients. METHODS: Women with anovaginal fistula and Crohn's disease treated surgically by one surgeon from 1988 to 1992 were retrospectively studied. RESULTS: Forty-eight women underwent treatment for anovaginal fistula caused by Crohn's disease. This represented 55% of the total patients seen for anovaginal fistula from all causes. Nine patients had severe anorectal and/or colonic disease and underwent total proctocolectomy with ileostomy. Four other patients had seton placement only. The remaining 35 patients underwent transanal repair of their fistula and are the basis of this study. Three types of flap repairs were performed curvilinear advancement rectal flap (n = 24), linear advancement rectal flap (n = 6), and advancement sleeve flap (n = 5). The type of surgery selected depended on the associated anal and colorectal disease. Diverting ileostomies were used in nine patients with a successful outcome in eight. Healing occurred with the initial repair in 19/35 (54%). An additional five patients underwent successful repeat procedures for an overall success rate of 24/35 (68%). CONCLUSION: Surgical closure of anovaginal can be offered to selected women with Crohn's disease, thus avoiding a permanent stoma in this group. The type of flap chosen for repair depends on the characteristics of the fistula.